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Background: Primary iliopsoas abscess is extremely rare in neonates and overlooked easily. It is potentially curable with surgical drainage and broad-spectrum antibiotics if diagnosed early. Case presentation: A 13-day-old neonate was presented with a swelling and bluish discoloration on the left thigh and groin. There was a restriction of movement of the left lower limb, and he developed high grade fever later on, during hospital stay. In spite of a great dilemma, we could finally reach the diagnosis of primary iliopsoas abscess, performed surgical drainage, and controlled ongoing sepsis. At 3 months follow-up, the patient was doing well and there was no asymmetry in appearance of movements. Conclusion: High index of suspicion, vigilant clinical examinations, and targeted laboratory investigations with imaging studies are of paramount importance in establishing its diagnosis. This case highlights the diagnostic difficulties and re-evaluates the representative features of neonatal iliopsoas abscess and its management. [ABSTRACT FROM AUTHOR]

Iliopsoas abscesses (IPAs) associated with bowel obstruction due to colon cancer are rare, and there is no consensus regarding treatment strategies. A 63-year-old man presented with swelling and pain in the right iliac region. Imaging studies revealed an IPA expanding from the psoas major muscle and retroperitoneal space subcutaneously around the right ilium. After percutaneous drainage, the patient developed bowel obstruction secondary to colon cancer. Hemicolectomy and preventive ileostomy were performed at the gastrointestinal surgery department, and chemotherapy was administered at the medical oncology department after ileostomy closure. Three months later, local recurrence was confirmed in the right iliac region, and the recurrent lesion, including the ilium, was widely resected. One and a half years after the reoperation, there was no recurrence. An IPA due to colorectal cancer without obvious perforation can also occur, and the treatment of IPAs depends on their size, location, shape, and presence of gas. Minimally invasive and staged treatment is preferable for IPAs due to colorectal cancer because the surgical mortality rate for colorectal cancer with local abscesses is high. Colorectal cancer should be considered as a cause of IPAs. Treatment of IPAs caused by colon cancer should be performed in a less invasive manner after considering their size, location, shape, and the presence of gas. Cooperation between gastrointestinal surgeons and oncologists is essential for managing patients with an IPA due to colon cancer complicated by bowel obstruction. • We report a rare case of iliopsoas abscess due to colon cancer. • The patient developed bowel obstruction after percutaneous abscess drainage. • Hemicolectomy and chemotherapy were performed in the relevant departments. • Recurrent lesions, including those in the bone, were widely resected. • A less invasive technique for abscess drainage and staged surgery should be chosen. [ABSTRACT FROM AUTHOR]

A newborn baby with an unusual complaint of transient left leg cyanosis during crying, who was diagnosed with a iliopsoas abscess is presented. Newborn cases diagnosed with an iliopsoas abscess in the English literature are summarized and differences in clinical presentations are discussed. [ABSTRACT FROM AUTHOR]

After bone marrow aspiration procedure; some complications like pain and bleeding at the puncture site may be expected but some serious complications like osteomyelitis and soft tissue infections may also rarely occur. In this case we present a boy with recurrent fever. During etiologic investigation, familial Mediterranean fever (FMF) gene M694V mutation was +/+. Patient was treated with oral colchicine however fever persisted. The patient was considered as colchicine resistant FMF and steroid treatment was planned. Bone marrow aspiration procedure was executed to rule out malignancy. Three months after bone marrow aspiration, he was readmitted with complaint of left pelvic pain, difficulty in walking without support and standing on his left foot. Radiological imaging demonstrated left iliopsoas abscess and left sacroiliac osteomyelitis. Patient was successfully treated with intravenous ampicillin-sulbactam and clindamycin treatment for 6 weeks. Then oral amoxicillin-clavulanic acid treatment was continued for 2 weeks. Patient was discharged without any surgical procedure. On 1-year follow-up he could walk without any support. [ABSTRACT FROM AUTHOR]

We present a case of iliopsoas abscess secondary to inflammatory bowel disease associated to glycogen storage disease 1b in a 12-year-old boy. To the best of our knowledge, a similar case has not been reported in medical literature. [ABSTRACT FROM AUTHOR]

Psoas abscesses are usually confined to the psoas compartment due to its fascial attachments. However, in rare situations, the infection can locally spread beyond the psoas sheath. A 65-year-old patient presented with; 3 weeks of lower back and right hip pain, progressive inability to walk and one week of urinary incontinence. CT abdomen showed a right psoas abscess with pneumo-retroperitoneum extending to the right gluteus muscle, posterior compartment of the upper thigh and mediastinum. Exploration in theatre showed copious amounts of pus, visible between the fascial layers and muscles of the thigh, tracking to the level of the knee and the gluteal region. Psoas abscesses are usually confined to the psoas compartment. However, in this case, it was spread to the posterior compartment of the thigh, gluteal region and pelvis with fascial necrosis and pus. Due to the extensive nature of the disease and the patient's clinical deterioration, he underwent open drainage of the psoas abscess, exploration and debridement of the posterior compartment of thigh and gluteal region with a good outcome. Psoas abscesses can penetrate the psoas sheath to cause extra pelvic extension. A high index of suspicion and early imaging, if necessary, should be arranged if in doubt. Depending on the clinical severity, patients may need to be managed with open drainage and debridement than conventional CT-guided drainage. • Clinical symptoms of psoas abscess can be non-specific and can cause a dilemma in diagnosis. • Extra pelvic extension of psoas abscess is rare. • Extra pelvic sites of psoas abscess extension can include posterior compartment of thigh and gluteal region. • Pneumoretroperitoneum can track via aortic and oesophageal hiatus, and lumbosacral arches to mediastinum causing pneumomediatinum. • Treatment for psoas abscess is CT guided percutaneous drainage and antibiotics; however, may need open exploration depending on the severity. [ABSTRACT FROM AUTHOR]

In most cases, ingested foreign bodies pass in alimentary tract silently. Rarely, ingested foreign bodies enter vermiform appendix. However, when it happened, they cannot reenter alimentary tract and may result in an inflammatory process. We report a case of iliopsoas abscess secondary to ingested metallic foreign body penetrating appendix. A 2-year-old child presented to our unit with her mother complaining that her child developed fever, repeated vomiting, and abdominal distension after one week of accidently ingestion of a rusty veil pin. Abdominal examination revealed right iliac tenderness and rebound tenderness. Abdominal ultrasound and multi-slice computer topography (MSCT) with intravenous contrast and gastrograffin enema revealed right iliopsoas abscess and metallic foreign body piercing appendicular wall with its tip seen in the iliopsoas abscess. We do appendectomy via transabdominal approach with good drainage of the abscess cavity. We discharged our patient on the fifth day postoperatively. The ingestion of inedible and indigestible objects is frequent in children. In most cases, ingested foreign bodies (FB) pass in alimentary tract silently. Rarely, ingested foreign bodies enter vermiform appendix and if it happened it may result in devastating complications as iliopsoas abscess. The is necessary to increase awareness of potential complications of ingested foreign bodies, especially in children. [ABSTRACT FROM AUTHOR]

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Iliopsoas abscesses (IPA) are rare and typically present with a non-specific triad of fever, back pain, and antalgic gait. Staphylococcus aureus is the organism responsible for nearly 90 % of IPA cases. We present a case of primary IPA with progression to osteomyelitis and discitis due to Salmonella enterica bacteremia, an exceedingly rare etiology occurring in an otherwise healthy individual. This patient presented with fever, back pain, and hip pain. Initial imaging and laboratory workup did not reveal any source of infection. He became septic within 72 h of admission, and blood cultures were confirmed as Salmonella enterica. However, the etiology of the infection remained unclear. Computed Tomography (CT) imaging revealed a right-sided psoas abscess measuring 7 mm × 7 mm and an epidural phlegmon. He was discharged home with intravenous ceftriaxone and levofloxacin. However, the patient was readmitted due to L2-L3 osteomyelitis and discitis with an eccentric disc bulge causing compression of the right L3 nerve root and neutropenia. This case in unique in the fact that this occurred in a healthy patient with no significant risk factors or exposure to this bacteria. Additionally, this case highlights the rapid progression of IPA and the spread to adjacent spinal structures with the potential to cause nerve compression with successful medical management. Salmonella enterica is rare cause of iliopsoas abscess. This case emphasizes the importance of including iliopsoas abscesses as a differential diagnosis in patients with a high index of clinical suspicion. • Iliopsoas abscess (IPA) is a rare occurrence that can rapidly lead to septic shock. • Salmonella is a rare cause of iliopsoas abscesses. • Clinicians should keep IPA on their differential for prompt treatment. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Iliopsoas muscle abscess (IPA) is considered a rare disease whose etiology has changed depending on the country and antibiotic selection pressure. This study evaluates the changes in etiology, clinical outcome, and risk factors for mortality for IPA. Methods: We reviewed the medical records of a total of 116 patients with IPA who were admitted to 4 university hospitals in Korea over the 11 years, and compared the etiology between 2001 and 2006 (period 1, n = 44) and 2007–2012 (period 2, n = 72). Results: Among 75 cases with a definitive microbial diagnosis, the predominant etiological organisms were Staphylococcus aureus (45.3%), followed by Mycobacterium tuberculosis (14.7%) and Klebsiella pneumoniae (9.3%). The percentage of MRSA in period 2 increased remarkably compared to period 1, from 25% to 44.4%, and incidence of M. tuberculosis from 7.1% to 19.1%, although these were not statistically significant. The overall mortality was 6.8% in period 1, and 13.9% in period 2, and sepsis as an initial manifestation (OR 293.5, CI 7.1–12,034.4, P = 0.003) and serum creatinine level (OR 0.43, CI 0.23–0.80, P = 0.008) were independent predictors of mortality. Invasive procedure improved the prognosis in cases with microbiologic confirmed pyogenic psoas abscess (46/50 [92%] vs. 9/14 [64.3%], P = 0.008). Conclusion: The incidence of MRSA as a cause of IPA is on the increase. Although the overall prevalence of tuberculosis is decreasing, tuberculosis is still an important cause of IPA. Initial clinical status and invasive intervention can lead to favorable outcomes. [Copyright &y& Elsevier]

Summary: Objectives: Iliopsoas abscesses (IPAs) are rare infections involving purulence within the muscles of the iliopsoas compartment, seldom due to Methicillin-resistant Staphylococcus aureus (MRSA) historically. This study was designed to evaluate the clinical characteristics and outcomes of patients with IPAs. Methods: A retrospective analysis of the demographics, clinical presentation, microbiologic data and treatment modalities among patients with IPAs from 1993 to 2007 at The Johns Hopkins Hospital was performed. Results: Among 61 patients with IPAs, infection rates increased from 0.5 cases/10,000 admissions (1993–2004) to 6.5 cases/10,000 admissions (2005–2007) (P < 0.001). An adjacent infectious focus was identified in 80% of patients, from skeletal (48%), intra-abdominal (23%), vascular (5%), genitourinary (3%), and cutaneous sources (2%). During 2005–2007, MRSA became a predominant pathogen, accounting for 25% of all cases and 37% of cases with a definitive microbiologic diagnosis (P = 0.006). Patients with IPAs >2 cm were more likely to undergo drainage, with trends toward longer hospitalizations, longer antibiotic courses, and increased odds of securing a definitive microbiologic diagnosis. Conclusions: Since 2005, rates of IPA have dramatically increased, with MRSA now the leading cause of infection. Knowledge of common pathogens should guide antimicrobial therapy including empiric coverage for MRSA in institutions with similar populations, especially if culture data are not available. [ABSTRACT FROM AUTHOR]

Abstract: Various types of collections can occur around the transplanted kidney. We present one such rare complication of psoas abscess underneath the transplanted kidney. Patient was on immunosuppression therapy post transplant and already had pulmonary tuberculosis treated with anti-tubercular treatment. Psoas abscess was diagnosed on subsequent follow up and managed successfully with ultrasound guided placement of percutaneous drainage catheter along with antibiotic therapy based on the culture report. Percutaneous drainage in combination with antibiotics is a viable alternative to more invasive surgical drainage for management of psoas abscess in post transplant patients. [Copyright &y& Elsevier]